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Physical Therapy Options in the COVID Era

Wondering how you’ll manage PT after surgery if COVID-19 shuts things down again? Dr. Lawrie discusses a few options available either in-person or remotely. 

If you’re considering having hip or knee replacement surgery, you may be concerned about how the COVID-19 pandemic will affect everything from preparing for surgery, to your hospital stay, through your recovery. Specifically, you may be concerned about how physical and social distancing requirements will affect your ability to work with a physical therapist during your recovery. In this article, we will discuss remote alternatives to traditional in-person physical therapy.

Do I really need in-person physical therapy after a hip or knee replacement?

Hip and knee replacements are intended to help patients return to a more active lifestyle. After surgery, a focused exercise program is important to achieve this goal.

Traditionally, physical therapy (PT) has been performed under the supervision of an in-person physical therapist. Depending on where you live, COVID-19 restrictions may have limited your ability to see a physical therapist. You also may be hesitant to leave your home after surgery to go to PT over concerns about COVID-19 transmission.

If you are unable or unwilling to see a physical therapist in the current COVID-19 environment, there is good news: some recent research1-4 suggests that many patients are capable of achieving equivalent functional outcomes after hip and knee replacement with or without traditional in-person PT. In fact, some newer alternatives go beyond PT to include appropriate educational information for your stage of recovery and a communication tool to interact with your surgeon team. As an added benefit, these newer alternatives can give your surgeon up-to-date information about the progress of your recovery. 

Traditional home exercise programs

The most basic option, a home exercise program can be used in conjunction with in-person PT for recovery after knee or hip replacement surgery. Handouts are given to patients before surgery, or in the hospital after surgery, with a schedule of exercises to perform for the first 2-3 months of recovery. These handouts typically contain instructions on the exercises and have picture demonstrations. This low-tech option may be suitable for motivated patients without access to technology.

Remote physical therapy visits: Live PT without physical contact

The delivery of healthcare via videoconferencing applications has exploded during the COVID-19 pandemic and physical therapy is no exception. An increasing number of physical therapists are offering “virtual” visits. These visits have most of the same benefits as in-person physical therapy, including therapist supervision and a therapist directed home exercise program, delivered in the comfort of the patient’s home via videoconference.

This option requires a device capable of videoconferencing, but no other specialized equipment or technology. Using videoconferencing, therapists will walk patients through a complete physical therapy session, monitoring their progress and performance. As with traditional in-person PT, visits are done 2-3 times per week for several weeks after surgery, and the program can be tailored by the therapist, to fit the patient. Patients may prefer this option if they want to avoid in-person contact with a therapist, but still like the idea of having a therapist “coach” along their recovery. 

Virtual physical therapy platforms

A variety of smartphone and tablet based virtual physical therapy platforms are now available. All platforms share the common feature of guided home exercise programs that are designed by physical therapists and physicians to maximize your recovery. Daily exercises are prescribed through the app with comprehensive education and exercise movements provided through descriptions, pictures and video demonstrations. 

Some of the platforms include extra features beyond PT, including education, messaging, and activity monitoring. Regarding education, timely messages are delivered directly to your smartphone or tablet. These focus on helping you advance your current stage of recovery. Additionally some applications have resource centers built in, where answers to common patient questions can be found.

Messaging features allow you to directly communicate with your surgical team through the platform, helping keep you connected and engaged. Activity monitoring can be performed using your smart phone, a wrist-based activity monitor or “smart” knee brace depending on the application you use. These activity monitors allow for data about your functional recovery, including step count, heart rate, knee range of motion, and sleep, among others. These features give your surgeon real-time data to help you make strong progress through your recovery.

This must be prescribed by your surgeon and requires patients to have a modern generation smartphone capable of running the platform, as well as patient comfort and confidence with this type of technology. This option may be best suited for patients who are self-motivated to complete the exercise program, yet still desire the surgeon team to monitor and be actively engaged in their recovery process.

Take home message

By leveraging new and existing technologies, surgeons and patients may work toward the same recovery goals without traditional in-person PT. However, these alternatives are not suited for every patient, so it is important to discuss them with your surgeon and determine what is best for you.

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References
  1. Fleischman, AN., et al. (2018, Jan). John N. Insall Award: Recovery of Knee Flexion With Unsupervised Home Exercise Is Not Inferior to Outpatient Physical Therapy After TKA: A Randomized Trial. Clin Orthop Relat Res. 477(1):60-69. doi: 10.1097/CORR.0000000000000561. PMID: 30794229; PMCID: PMC6345292.
  2. Kuether J., et al. (2019, Oct). Telerehabilitation for Total Hip and Knee Arthroplasty Patients: A Pilot Series with High Patient Satisfaction. HSS J. 15(3):221-225. doi: 10.1007/s11420-019-09715-w. Epub 2019 Aug 21. PMID: 31624476; PMCID: PMC6778164.
  3. Prvu Bettger, J., et al. (2020, Jan 15). Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Joint Surg Am. 102(2):101-109. doi: 10.2106/JBJS.19.00695. PMID: 31743238.
  4. Russell, TG., et al. (2011, Jan 19). Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 93(2):113-20. doi: 10.2106/JBJS.I.01375. PMID: 21248209.